Symposia
LGBQT+
Sarah E. Valentine, Ph.D.
Assistant professor
Boston University School of Medicine and Boston Medical Center
Medford, Massachusetts
Joelle Taknint, PhD
Staff Clinical Psychologist
Boston Medical Center
Boston, Massachusetts
Lorenzo Guani, MPH
Graduate Research Assistant
Boston Medical Center / Boston University School of Public Health
Boston, Massachusetts
Laura Godfrey, BS
Research Assistant
Boston Medical Center
Boston, Massachusetts
Due to systemic and interpersonal discrimination, exclusion, and violence, gender minority status may place TGD people at elevated risk for assault and poor posttraumatic adjustment. Despite documented disparities in trauma exposure and PTSD among TGD people, there is a gap in the conceptual research on how gender minority status may produce vulnerability for assault and poor posttraumatic adjustment. Qualitative methods are suitable and necessary so that integrated conceptual models for minority stress and traumatic stress are informed by the lived experiences of TGD people. We conducted in-depth interviews with TGD adults (N=44), including transwomen/women (n = 17), transmen/men (n=11), non-binary or genderqueer people (n=10), and people with another minoritized gender identities (n=6). Interview questions were anchored to an inventory of potentially traumatic events. For each event endorsed, participants were asked a) how/whether they perceived their gender identity to be related to exposure to that event (trauma context), and b) how/whether they perceived their gender identity to have influenced their psychological recovery. Additional probes were used to understand the impact of gender identity on cognitive, behavioral, and affective responses trauma. Assaultive traumatic events were most commonly linked to gender identity, and were experienced by 77% of the sample. Respondents described interpersonal factors that produced a vulnerability to assault, including social isolation and rejection and power differentials within relationships (e.g., respondents described entering relationships or housing situations despite “red flags” due to fewer options for safe environments). Key factors impacting psychological recovery were a) inaccessibility of safe and affirming legal, medical, and informal supports, b) emotion dysregulation (attributed to chronic invalidation), and c) cognitive appraisals, including posttraumatic cognitions reflective of internalized transphobia (shame, self-blame, self-worth) and more nuanced appraisals of trust and safety (which may be adaptive in some contexts). Similar to trauma, minority stressors may lead to intrapersonal changes in threat perception and emotion regulation abilities, and these clinical features are relevant to the treatment of PTSD. We conclude that a) PTSD treatments ought to consider social context in the application of cognitive reappraisal and exposure techniques and b) additional coping strategies may be needed to bolster resistance to minority stress.